J Transcat Intervent. 14/Jun/2018;26(1-2):a0001.
Left distal transradial access: up to snuff?
In the years since radial artery access for coronary angiography was first described in 1989, a plethora of evidence has shown the superior safety, costs, and quality of life benefits of this approach compared with femoral artery access.– Due to mostly ergonomic considerations, right radial access continues to be favored over left radial approach, although use of left radial artery may be advantageous in certain cases: presence of a left internal mammary artery graft, right radial artery occlusion, right radial or subclavian tortuosity, short stature, and patient preference. Several studies have also shown decreased fluoroscopic time and contrast use with routine left radial access compared to right radial access, potentially related to the increased prevalence of subclavian tortuosity and geometric disadvantages of the subclavian-innominate-aorta axis from the right radial approach.,
Left distal transradial access (ldTRA) is a new technique that seeks to combine the advantages of a left radial approach with an ergonomic comfort. Described initially in 2011 by Babunashvili and Dundua to retrogradely open occluded ipsilateral radial arteries, ldTRA has only recently been described as a potential alternative to traditional radial artery cannulation for coronary angiography and interventions. ldTRA is performed by positioning the patient’s left arm towards the patient’s right groin, pronating and flexing the wrist to bring the radial artery to the surface of the anatomical snuffbox, and cannulating the radial artery in the snuffbox on the dorsum of the hand. This position – compared with traditional left radial access – allows the operator to comfortably obtain access from the usual right side of the patient, keeps the patient’s left arm at a close distance to the operator throughout the procedure avoiding the need for the operator to bend over the patient, and maintains the arm in a more natural position for the patient., Since ldTRA is a novel method, few studies have evaluated the safety, feasibility, and outcomes of the technique.